AccountId: 011433970860
ContactId: 1bf33483-99c4-43c7-ab17-94870b3f7e94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 951010 ms
Total Talk Time (AGENT): 267395 ms
Total Talk Time (CUSTOMER): 551084 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/1bf33483-99c4-43c7-ab17-94870b3f7e94_20250609T21:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], how are you doing? I'm just calling to uh confirm some information on the letter that I received. I got something about says dear policy holder, we received a claim on your policy. I, I didn't know anything about a claim on there.
[AGENT][NEUTRAL] OK, sometimes the providers file claims as well, but I can definitely check on your policy and see what's going on there for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, my name is, uh, [PII]. Um, a good contact number is [PII].
[AGENT][NEUTRAL] Thank you, and your policy number?
[CUSTOMER][NEUTRAL] Um, I, I don't know what that is for.
[AGENT][NEUTRAL] OK, on the
[CUSTOMER][NEUTRAL] The American public life is, is.
[AGENT][NEUTRAL] On the letter that you received, does it say a reference number?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] No, ma'am, I don't, I don't have a reference number on here.
[AGENT][NEUTRAL] OK, can you, well, I can look the policy up with your first and last name or your full social?
[CUSTOMER][NEUTRAL] Um, yeah, I could do either option. Um my first name is [PII] um last name is uh [PII], [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Does this APO has something to do with like a uh a benefits and card because I do have like a benefits and card is that what it's a part of?
[AGENT][NEUTRAL] Yes, we do work with benefits and a card, um, that they're kind of like the
[AGENT][NEUTRAL] They're kind of like the middle man between the employer and us because all of our policies are through the employer.
[AGENT][NEUTRAL] Um, this is the employer then uses this, um, benefits in a card to make changes on the policy because everything that's changed or updated has to be done in writing, so business workers I'm sorry, benefits in a card handles that for your employer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Um, hold on one second.
[AGENT][NEUTRAL] OK, so I have you here and is this for your medical policy or you just want me to, well, uh,
[AGENT][NEUTRAL] Or dental.
[CUSTOMER][NEUTRAL] Um, I guess this is medical. I'm just trying to figure out like what claim was done because um I got the letter on [PII] and just says something about we received the claim on your policy and the review of the claim has started.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so I can look and see which one has a claim on it. Um, I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[CUSTOMER][NEUTRAL] Um, what was the other options that you asked me to do?
[AGENT][NEUTRAL] Um, your email and mailing address.
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[CUSTOMER][NEUTRAL] Um, the email address is.
[CUSTOMER][NEUTRAL] I have so many email addresses, um.
[CUSTOMER][NEUTRAL] I believe for this I used uh [PII].
[AGENT][POSITIVE] Yes, and thank you so much for verifying your information.
[AGENT][NEUTRAL] So I am showing on the medical policy, there was a claim that came in on [PII], um,
[AGENT][NEUTRAL] And it looks like it processed on [PII], but we couldn't pay out because the data of service was before the policy became effective. Let me see. So it looks like it's from [PII] from Kingston Phy Physicians Group.
[CUSTOMER][NEUTRAL] Oh, OK, so, oh yeah, that was, yeah, because I try to see if my benefits and card would maybe help me pay um because I had.
[CUSTOMER][NEUTRAL] I had a really bad case of the flu, uh back in March and
[CUSTOMER][NEGATIVE] At the time I didn't have any kind of benefits or or anything um so they've been trying to get me to pay a.
[CUSTOMER][NEGATIVE] A pretty large bill. It's like over $3000 and.
[CUSTOMER][NEGATIVE] I just don't have the money to do that and once I got this card through my job I just.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was trying to see if it was, you know, even.
[CUSTOMER][NEUTRAL] Maybe some kind of a
[CUSTOMER][NEUTRAL] Lifeline, you know, to try to see if it would help me pay for that, but I guess that's what it was meaning by a claim then.
[AGENT][NEUTRAL] Yeah, for that one, I'm not sure about it, um.
[AGENT][NEUTRAL] Only because, let me see if the second one is the same. Hold on one second because it looks like.
[AGENT][NEUTRAL] Let me make sure.
[AGENT][NEUTRAL] OK, these are two different claims. Let me see the first one.
[AGENT][NEUTRAL] So the first day of service is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] But it was denied for the same reason because the policy um didn't become effective.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] you may.
[AGENT][NEUTRAL] Until May, and these are for February and March.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, yeah, that, that's both of the times that I went to the hospital. The one in March was uh when I had a bad case of the, the flu. I, I kinda had a longer version of the flu than, uh, the normal version usually it's like 5 days. Mine was for about 2 weeks, um, and in February I was having some issues with like some really um abnormal chest pain. Um, we never really figured out what the cause of that was they just put me on a temporary.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Inhaler and I used that and so I didn't really feel like I had to use it anymore. So I mean I've been fine since then. I, I've actually stopped using it a long time ago, but they never figured out what caused the chest pains or anything, um.
[CUSTOMER][NEUTRAL] But yeah I I just I I didn't have medical insurance for either one of those and I I know I didn't get the benefits in a card until I think like [PII] um.
[CUSTOMER][NEUTRAL] I just didn't know if I was able to like backtrack and use this for those, but I, I guess it has to be like it has to be used now for things that come after the benefits are activated.
[AGENT][NEUTRAL] Right, now anything after [PII], um, yes, you can go ahead and start sending those in to be processed.
[CUSTOMER][NEUTRAL] OK, alright, so every everything after [PII], OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] The only thing that I've been kind of uh I guess a little bit mixed up on from when I called like the benefits in the card it's like an 800 number they have on here uh she's telling me that if there are weeks where my paycheck comes out and the deductions don't come out of my check, she said then the following week I don't have those benefits like, um, in motion. So if I had to use them that following week they would kind of be denied because they didn't take out the deduction from a paycheck.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I had a weird thing that happened with my paycheck this past week, uh, on, on Wednesday I got paid and it shows on the pay stub that they went to take out all the amounts of the money that's for each deduction that comes out for the benefits and it shows where it was minus it and then at the very end of my pay stub they put a a credit and they credit that same amount back so then when it says where the deduction amount usually would come out, which is supposed to be 56 $75 each week, it shows $0.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I was, you know, I was kind of like why did it show that it was taken out of the pay stub and then added right back so it kind of made me feel like then I didn't have benefits for this week because they say that it always works like the, the following week in advance if they came out of my paycheck so like.
[CUSTOMER][NEUTRAL] I was just kind of confused about that.
[AGENT][NEUTRAL] Yes, that's true.
[AGENT][NEUTRAL] Um, because it is a temp, um.
[AGENT][NEUTRAL] Assignment or a temp job that um basically you pay for the week upcoming. So if there's no payment, then the week upcoming, there's no coverage. Um, we have to do what's called the eligibility report and we check with the um benefits in the car to see if you're eligible for um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like pay out on a certain date of service, you know, if you were to have a claim in, we would check and see that you were eligible for services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh I got you, um.
[CUSTOMER][NEUTRAL] Do you have any idea of what would have caused that situation to happen this past week where it did show all of the amounts of each uh service that I have like with you guys like how I have the net impact and the net coverage and the um vision, dental um and all that other stuff, um.
[CUSTOMER][NEUTRAL] Do you know exactly what would cause it to like show up on the.
[CUSTOMER][NEGATIVE] On the pay st that it was taken out and then it was all credited back like I don't I I don't quite understand that one.
[AGENT][NEUTRAL] Now, that's a question for your employer because you're on payroll deduction. So APL really doesn't know. Um, your employer will take it out for, you know, from the paycheck and then a third party pays us. So I don't know what the, what caused that, that would be the employer with the deduction.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, but pretty much if the pay stub said that the deductions was a $0 amount, that means I didn't have benefits for this week. Is that what I'm understanding?
[AGENT][NEUTRAL] Correct. If nothing was deducted, then no, you wouldn't have uh benefits.
[CUSTOMER][NEGATIVE] Yeah, I wonder if that's what's been messing with my, um, my card then because I had to go to my doctor today. I've been, uh, I've been a little sick today as well. Um, don't know exactly what's going on yet. Um, I'm waiting to hear back from some results and they, the doctor I talk to me out of work until Thursday, um.
[CUSTOMER][NEUTRAL] And I try to give them my new, you know, benefits in the card thing to try to run it on that, see, you know, if it could be used at the, um, the doctor's office and the first time that they used the card when I, I, my first card that I got from you guys, the RXIN number and the RXPCN on the pharmacy, uh, the numbers are right, but they were in the wrong position and um the pharmacy notified me of that and that's why I already called uh benefits on the card and they sent me another one so I got everything correct on the new card.
[CUSTOMER][NEUTRAL] Um, I don't know if that had something to do then with the, um, doctor's office because they called when I called to make an appointment to see them about my situation today, they said that when they tried that card, uh, a week or so ago when I saw my doctor, it was, uh, out of their network is what she said, um, and I did give them the new card today uh to try to run it and stuff but um.
[CUSTOMER][NEGATIVE] Yeah, if I don't have benefits for this week that it's probably not even going to allow them to.
[CUSTOMER][NEUTRAL] So like use it even if it you know could be within their network is that is that what I'm understanding?
[AGENT][NEUTRAL] Right, if yes, um.
[AGENT][NEUTRAL] But now I will still reach out to the employer to see if the, because it was deducted and then it was put back.
[AGENT][NEUTRAL] Is that what's happening?
[CUSTOMER][NEUTRAL] Yeah, it was such a weird thing. Mhm. Yeah, it was such a weird thing. I mean because my pay stub deliberately shows that shows like all the it like for each each service that I have with you guys with the benefits of the card, it showed it like being minus, you know, like deducted out like normally and then um there's a part like towards the right of the pay stub and then it shows that all those amounts, you know, usually make the total amount of 5675 that then would show up in the deductions box.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, like it normally does, but then the deduction box for that paycheck says 0, and there was a credit at the right part of the sheet that said 5675. So it's like they took all the deductions out and then kind of credited the 5675 again. So that's what then made the deduction box that show zero. So I, I don't, and I've not gotten any information on that from, from anyone, um, I've tried to find out about it with my employer and stuff, but I haven't heard anything.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah, on that one it's
[CUSTOMER][NEUTRAL] It was just weird. I didn't quite understand that one.
[AGENT][NEUTRAL] Yeah, that's kind of hard to advise on the best and the only reason I'm redirecting to the employer is because that's who actually initiates the payroll deduction. So they will be able to let you know if there was an error when they were trying or because that does that, that does sound a little off. I'm not sure.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What happened with that?
[CUSTOMER][NEUTRAL] Yeah, absolutely, I mean, I, I can try to check with them about it again, um, just to try to push it further and see if I can get some information on that, but as of right now I don't quite understand like why I did that. But I mean I am understanding though that if it it shows $0 in that box and technically that means I don't have those benefits for this week.
[AGENT][POSITIVE] Correct, that's right.
[CUSTOMER][NEGATIVE] And so that would mess up with the doctor's office if they try to run this card to see if they even could be used at their facility, right?
[AGENT][NEUTRAL] Well, the doctor should still file the claim regardless if
[AGENT][NEUTRAL] If you just didn't have benefits for that week, we will let them know, but I would, we would encourage them to go ahead and file the claim so that if there are benefits that can be applied, we can definitely apply them.
[CUSTOMER][NEGATIVE] Oh yeah, because like if if if it was to kind of give them a hard time right now since there was no benefits technically right now and you guys notified them of that when I would have them come out of my paycheck this week which I'm hoping and pray they do come out this week like they're supposed to not be credited back like they were last week then I know that I'd have benefits for um the next week so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The following week. Mhm.
[CUSTOMER][NEUTRAL] Mhm. So that's, that should kind of.
[CUSTOMER][NEUTRAL] Maybe I guess ease that a little bit and then like that would allow them like if they can still do it and it's not with like out of their network and then be able to file the claim and, you know, use the card for the um insurance so.
[CUSTOMER][NEUTRAL] So I just have to see what happens from here.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh no ma'am, thank you for explaining everything about like what this uh letter from [PII] was about and that kind of makes sense now because I know it had now it kind of reminds me that I did try to see if it could be used for the services that I did in February and March, but I know that that's too far back from when the actual date of the benefits was um.
[CUSTOMER][NEUTRAL] Initiated so
[AGENT][POSITIVE] Yes, sir. Well, thank you so much for calling APL. If you need us, definitely give us a call. We'll be more than happy to assist you, OK?
[CUSTOMER][POSITIVE] Yes ma'am thank you you have a good day.
[AGENT][POSITIVE] You're welcome, you also. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye.